Dr Mark Overton
Clinical Lecturer & Physiotherapist, Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, NZ
Mark is a physiotherapist and has been working as a part of an interdisciplinary pain team in Christchurch and Dunedin for the last 10 years. He gained a Master of Physiotherapy from the University of Otago in 2017 and recently completed his PhD which explored pain sensitisation and knee osteoarthritis pain experiences. Alongside his clinical work, Mark is currently a Clinical Lecturer and Paper Coordinator for PAIN711: Introduction to Pain Management at the University of Otago. Mark’s research interests include chronic pain, pain mechanisms, knee osteoarthritis and ecological momentary assessment methods.
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Does Sensitisation Predict the Variable Knee Osteoarthritis Pain Experience?
Authors
Mark Overton*, Nicola Swain, Carrie Falling, David Gwynne-Jones, Roger Fillingim, Ramakrishnan Mani
Co-investigators: Associate Professor Nicola Swain, PhD1 Co-investigator: Dr Carrie Falling, PhD1 ; Professor David Gwynne-Jones, BM BCh2 Co-investigator: Professor Roger Fillingim, PhD3 Principal Investigator: Dr Ramakrishnan Mani, PhD1
1. Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago
2. Department of Surgical Sciences, Otago School of Medicine, University of Otago
3. Pain Research and Intervention Center of Excellence (PRICE), Department of Community Dentistry and Behavioural Science, University of Florida
Background
Knee Osteoarthritis (OA) is a prevalent musculoskeletal condition that often results in pain and disability. Determining factors predicting variability in pain experience is critical to improving clinical outcomes. Underlying pain sensitisation and its clinical manifestations, such as activity related pain, may better predict the knee OA pain experience.
Purpose/Aim
This study aimed to determine whether Quantitative Sensory Testing (QST) derived sensitisation measures and activity-related pain predict knee OA pain experiences collected via smartphone ecological momentary assessment (EMA).
Methods
Individuals with knee OA were recruited from an urban community in New Zealand. Those eligible to participate underwent baseline QST with clinical measures of activity-related pain also being collected. The knee OA pain experience was collected via smartphone EMA three times daily for two weeks. Mixed effects location scale models were developed using a multilevel modelling approach.
Results
Eighty-six participants with knee OA participated in the study. Mean age was 67.3 years, with most of the participants being female (64%) and New Zealand European (90.6%). Activity-related pain predicted worse and more variable pain intensity, pain interference, and bothersomeness outcomes within and between individuals with knee OA. Widespread cold hyperalgesia and local mechanical hyperalgesia were shown to predict higher within-person variability in pain intensity and pain interference respectively, while mechanical temporal summation predicted less within-person variability in pain intensity and interference.
Conclusion and implications
Those demonstrating activity-related pain and sensitisation could be at risk of experiencing worse and more variable knee OA pain in the subsequent weeks. Testing for sensitisation in clinical practice could, therefore, identify those at greatest risk of higher and more variable knee OA pain experiences and in greatest need of treatment. Larger validation studies are required, which include individuals with more severe knee OA.
Funding: The Understanding Knee Osteoarthritis Pain Experiences (U-KOPE) study was supported by the Otago Medical Research Foundation Jack Thomson grant.
Mark Overton*, Nicola Swain, Carrie Falling, David Gwynne-Jones, Roger Fillingim, Ramakrishnan Mani
Co-investigators: Associate Professor Nicola Swain, PhD1 Co-investigator: Dr Carrie Falling, PhD1 ; Professor David Gwynne-Jones, BM BCh2 Co-investigator: Professor Roger Fillingim, PhD3 Principal Investigator: Dr Ramakrishnan Mani, PhD1
1. Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago
2. Department of Surgical Sciences, Otago School of Medicine, University of Otago
3. Pain Research and Intervention Center of Excellence (PRICE), Department of Community Dentistry and Behavioural Science, University of Florida
Background
Knee Osteoarthritis (OA) is a prevalent musculoskeletal condition that often results in pain and disability. Determining factors predicting variability in pain experience is critical to improving clinical outcomes. Underlying pain sensitisation and its clinical manifestations, such as activity related pain, may better predict the knee OA pain experience.
Purpose/Aim
This study aimed to determine whether Quantitative Sensory Testing (QST) derived sensitisation measures and activity-related pain predict knee OA pain experiences collected via smartphone ecological momentary assessment (EMA).
Methods
Individuals with knee OA were recruited from an urban community in New Zealand. Those eligible to participate underwent baseline QST with clinical measures of activity-related pain also being collected. The knee OA pain experience was collected via smartphone EMA three times daily for two weeks. Mixed effects location scale models were developed using a multilevel modelling approach.
Results
Eighty-six participants with knee OA participated in the study. Mean age was 67.3 years, with most of the participants being female (64%) and New Zealand European (90.6%). Activity-related pain predicted worse and more variable pain intensity, pain interference, and bothersomeness outcomes within and between individuals with knee OA. Widespread cold hyperalgesia and local mechanical hyperalgesia were shown to predict higher within-person variability in pain intensity and pain interference respectively, while mechanical temporal summation predicted less within-person variability in pain intensity and interference.
Conclusion and implications
Those demonstrating activity-related pain and sensitisation could be at risk of experiencing worse and more variable knee OA pain in the subsequent weeks. Testing for sensitisation in clinical practice could, therefore, identify those at greatest risk of higher and more variable knee OA pain experiences and in greatest need of treatment. Larger validation studies are required, which include individuals with more severe knee OA.
Funding: The Understanding Knee Osteoarthritis Pain Experiences (U-KOPE) study was supported by the Otago Medical Research Foundation Jack Thomson grant.